Healthcare Provider Details

I. General information

NPI: 1073950036
Provider Name (Legal Business Name): AIMEE A DISHAROON CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78-6831 ALII DR STE 411
KAILUA KONA HI
96740-5403
US

IV. Provider business mailing address

PO BOX 1689
KEALAKEKUA HI
96750-1689
US

V. Phone/Fax

Practice location:
  • Phone: 808-650-3469
  • Fax: 808-319-2068
Mailing address:
  • Phone: 541-761-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10156092
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW-20
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: